Marc Siegel writes,

By the time a lung cancer is seen on an X-ray it is almost always too widespread to be operated on. Hence, the only chance for a cure is finding it before it has spread via a screening CT scan…

My patients want to know if they have cancer as early in the process as possible, and they want a plan to treat it. They don’t want to have to rely on mathematical projections or statistics about “hypothetical” death rates.

Recent studies, which Siegel mentions, suggest that lung cancer screening has no benefits, on average. But, he argues, his patients still want it.

This form of screening clearly falls into what in my book I call a “gray area,” meaning medical procedures that are not clearly cost-effective. Some patients may want it, but it is not absolutely necessary.

I have no problem with giving patients what they want, provided that they are paying out of pocket. But when consumers are insulated from the cost, this sort of premium, gray-area medicine is, in my view, the fundamental source of our problems in health care finance.